Determinants of lung health across the life course in sub-Saharan Africa

Abstract

LUNG HEALTH ACROSS THE life course is influenced by factors affecting airway and alveolar development and growth during antenatal and perinatal periods, throughout childhood and adolescence, and into adulthood. Lung function trajectories are set in early life and childhood deficits may predispose to non-communicable respiratory diseases, such as asthma and chronic obstructive pulmonary disease, in later years. Potential risk factors are common in many sub-Saharan African (sSA) countries; adverse antenatal environments cause in utero growth restriction and prematurity; HIV and respiratory infections, including TB are common; exposure to air pollution is widespread, including household air pollution from biomass fuel use, traffic-related pollution in rapidly expanding cities, and tobacco smoke exposure. Multiple disadvantages experienced in early life require an integrated approach that addresses reproductive, maternal and child health. Public health strategies need to tackle multiple risk factors, emphasising Universal Health Coverage, to maximise lung health in the world´s poorest, most vulnerable populations. This review explores potential determinants of lung health across the life course. Due to the extensive topic and wide range of related literature, we prioritised more recent citations, especially those from sSA, focusing on risk factors for which there is most information, and which are most prevalent in the region.

Bronchiectasis in African children: Challenges and barriers to care

“…Conflicting results have been reported on the long-term lung function trajectories of children in Africa, with the outcome or economic burden of BE in Africa largely unknown. Early HAART initiation has been associated with lung function improvement in the first 2 years following initiation, but this may not be sustained; the impact of nutrition on BE and lung function trajectories, needs further exploration, as severe acute malnutrition was not associated with worse lung function at seven years post-treatment, in survivors, however, this was not in children with BE ( 49 , 72 ). Longitudinal data needs to be collected on children with BE from Africa, to document the effect of differing etiologies of bronchiectasis on the long-term outcome of patients.…”

Exploring smoke: an ethnographic study of air pollution in rural Malawi

“…These are associated with poor air quality and share other causative factors such as poverty and malnutrition. [7][8][9] Cooking using biomass (organic matter used as fuel) is known to be important, although other sources of air pollution are also present. [10][11][12][13][14] With over 3 billion people worldwide relying on polluting fuels and technologies for cooking, these issues are key to global health.…”

“…Acute respiratory infection and chronic lung disease are common in this population. These are associated with poor air quality and share other causative factors such as poverty and malnutrition 7–9. Cooking using biomass (organic matter used as fuel) is known to be important, although other sources of air pollution are also present 10–14…”

“Honestly, this problem has affected me a lot”: A qualitative exploration of the socioeconomic impacts of chronic respiratory disease among people and their communities in Sudan and Tanzania

“…In our study setting, the extended family system and the social interconnectedness meant that any economic costs incurred by the person with CRD could lead to a ripple effect within their social circle, potentially setting up or exacerbating vicious cycles of poverty and ill-health. Life course studies have established that risk factors in childhood and adolescence, including poverty, contribute to subsequent development of CRD in adulthood(35). The economic impacts observed in this study risk perpetuating poverty and worsening outcomes such as morbidity and mortality.…”